Patient portals

Patient portals can give patients access to a personal health record and enable interaction with the health care system. Patient portals are creating unprecedented opportunities for using health IT to deliver care to patients, paving the way for benefits to patients, providers and the organizations that implement the portals. The objective of this dissertation has been to explore the role of the organizational context by identifying and describing factors affecting portals in different types of health service systems. We have let the following four questions guide the research. 1. What outcomes have been achieved through patient portals and how are these outcomes achieved? 2. How does the health service system context, in particular health service system integration or fragmentation, impact patient portal development and ability to achieve beneficial outcomes? 3. With focus on fragmented health service systems, how can patient portal development and achievement of beneficial outcomes be improved? 4. How can the existing evidence base inform patient portal development across health service systems and how can this evidence base be advanced? In answering these questions, we studied portals in integrated and fragmented health service systems in the United States and in the Netherlands. We relied on multiple qualitative methods, including literature review, document analysis, and interviews

Contextualising transforming rehabilitation: supporting short sentenced offenders with complex needs in a time of policy change

This thesis presents the findings of a qualitative exploration of the concept of effective rehabilitation within Transforming Rehabilitation (TR) – a programme implemented in 2015 to review the way offenders are rehabilitated in England and Wales. The study focuses on the programme’s radical changes to the commissioning, delivery and payment of rehabilitation services i.e. Payment by Results (PbR) and the mechanisms - as framed by Pawson and Tilley (1997)’s realist approach - through which it influenced the provision of effective rehabilitation in the community, especially to short-sentenced offenders with complex needs. Policy documents are examined to establish the theory behind TR. Interview data from service providers (including private and third sector organisations) and service users, across England, is used to explore the implications of TR on the ground and effective rehabilitation from their perspectives. This work suggests that PbR as designed under TR works against the principles of effective rehabilitation, which were found to be rooted in the mental health of the offenders. A theoretical perspective on how effective rehabilitation could be achieved and appropriately funded is proposed. The study recommends the adoption of a public health approach to addressing re-offending, with mental health at the forefront of the design of policies concerning offender rehabilitation. Qualitative data for the thesis is available: DOI 10.25500/edata.bham.00000756, https://doi.org/10.25500/edata.bham.0000075